COVID-19 Pandemic and Hospital Efficiency in Iran: Insight from an Interrupted Time Series Analysis and Pabon Lasso Model.

Abstract

Limited evidence exists on the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on hospital efficiency worldwide. This study aimed to investigate the impact of the COVID-19 pandemic on public hospitals in Iran. In this quasi-experimental study, monthly data on the average length of stay (ALoS), bed occupancy rate (BOR), bed turnover rate (BTR) and bed turnover interval (BTI) were collected for 58 months (36 months before and 22 months after the COVID-19 outbreak in Iran) from the health information systems of all 18 public hospitals affiliated with Kermanshah University of Medical Sciences in Kermanshah province, Iran. We used interrupted time series analysis and the Pabon Lasso model to investigate the impact of the COVID-19 pandemic on hospital efficiency. The monthly average ALoS, BOR, BTR and BTI before (after) the COVID-19 pandemic was 3.30 (3.48) days, 70.14% (49.37), 6.78 (4.81) patients per bed and 1.15 (2.88) days, respectively. The study indicated that a statistically significant decrease in ALoS of 0.29 and BOR of 25.09 in the first month following the COVID-19 pandemic. Compared with the before pandemic period, we observed a significant increase in the monthly trend of ALoS (coefficient = 0.021; p = 0.015), BOR (coefficient = 1.30; p = 0.002), and BTR (coefficient = 0.08, p = 0.012). We found a significant decrease in the monthly trend in BTI (coefficient = -0.11, p = 0.009) after the COVID-19 pandemic when compared with before the pandemic. Based on the Pabon Lasso model, before (after) the pandemic, 29.4% (29.4%) of the hospitals were located in zone 1 as an inefficient area, and 17.6% (35.3%) of hospitals were located in zone 3 as an efficient area. The study demonstrated that the BOR and BTR decreased substantially after the outbreak of COVID-19. In contrast, the ALoS and BTI have significantly increased following the COVID-19 pandemic. We also found that hospitals' performance in both periods was poor, and only 30% of hospitals were located in the efficient zone (zone three) based on the Pabon Lasso model. Further studies aimed at identifying the main factors affecting lower efficiency among hospitals in Iran are recommended.